Evaluation of a collaborative care program for patients with treatment-resistant schizophrenia: Protocol for a multiple case-study. (Preprint)

2021 ◽  
Author(s):  
Amy Jongkind ◽  
Michelle Hendriks ◽  
Koen Grootens ◽  
Aartjan Beekman ◽  
Berno van Meijel

UNSTRUCTURED Background Around one-third of all patients with schizophrenia are classified as "treatment-resistant". Across the globe, there is under-treatment with clozapine and other effective treatment options for people with treatment-resistant schizophrenia (TRS). In this respect, it appears that regular healthcare models do not optimally fit this particular patient group. The Collaborative Care model (CC) has proven to be effective for patients with severe mental illness, both in primary care and in specialized mental healthcare facilities. The key principles of the CC model is that both patients and informal caregivers are part of the treatment team, that a structured treatment plan is put in place with planned evaluations by the team, and that the treatment approach is both multidisciplinary in nature and uses evidence-based interventions. We have developed a tailored CC-program for patients with TRS (CC-TRS). In this paper, we provide an overview of the research design for a potential study that seeks to gain insight into both the process of implementation and the preliminary effects of CC-TRS. Moreover, we will aim to gain insight into the experiences of professionals, patients and informal caregivers with the program. Methods The study will be underpinned by a multiple case-study design (N = 20) that utilizes a mixed-methods approach. These case studies will focus on one Early Intervention in Psychosis Team (EIT) and two Flexible Assertive Community treatment (FACT) teams in the Netherlands. Data will be collected from patients’ records as well as through questionnaires, individual interviews and focus groups. We began the process of recruiting patients in October 2020. Discussion The research design is discussed in line with the aims of the study, which are framed within the process of developing and testing innovative interventions. The limitations in clinical practice as well as their specific consequences for this study are explained. Trial registration AsPredicted (#62738), pre-registration titled 'Collaborative care for patients with treatment-resistant schizophrenia', registered 13 April 2021. https://aspredicted.org/gk958.pdf.

Author(s):  
Helen Perks ◽  
Dominic Medway

This article investigates the nature of resource-based processes in the development of new ventures, adopting a business duality lens. Business duality occurs where a new venture is developed alongside an established business. The research employs a multiple case study methodology situated in the farming sector. The details of resource assembly and deployment are examined and presented through four stages of the entrepreneurial process: initiation, experimentation, mature and late stage. The findings offer insight into the manner in which resource ties between the businesses relate to processes of resource assembly and deployment and in addition, inform a business duality-based taxonomy. This depicting three generic approaches to managing resource-based processes in the development of new ventures in the farming sector: holistic innovators, reactive innovators and cautious innovators. We conclude by considering the implications of our arguments for new venture activity in other business duality contexts.


2020 ◽  
Author(s):  
◽  
Evgeniya Lupova

This research develops insight into the functioning of self-aware and organised clusters seeing these as ‘context-embedded meta-organisations’. Specifically, it builds a theoretical framework for strategy-making in organised clusters, elaborates on their ‘agentic’ nature and ability to shape their environments. Contrary to a more ‘traditional’, determinist, approach in cluster studies, viewing clusters solely as ‘geographic concentrations’ of organisations, the perspective adopted in this research conceptualises clusters as ‘organisations of organisations’. This suggests a more voluntarist stance where self-aware and organised clusters are perceived as intentional actors within their environments implementing deliberate strategies and pursuing system-level goals. This perspective is rather novel in cluster studies and opens up interesting research directions. This thesis explores two major implications of the ‘meta-organisational’ view of clusters: (1) the deliberate nature of collective strategy-making in these and (2) clusters’ ‘actorhood’ and their interactions with their contexts. First, seeing clusters as ‘organisations of organisations’, suggests that these can be deliberately managed and calls for the application of management studies to the cluster context. However, to date, most strategy tools and frameworks have been developed with an individual firm in mind. As a consequence, these cannot reflect the complexity of the ‘meta-organisational’ setting where a number of interests are at play, and strategy-making is a collective exercise. Thus, the ‘meta-organisational’ perspective on clusters calls for the adaptation of the extant strategy frameworks to account for the specifics of the setting. To answer the need for strategy tools and approaches adapted to the context of clusters seen as meta-organisations, this thesis proposes a novel framework of the ‘cluster business model’. This topic is addressed in Article 1 adopting a design science approach to develop a practical tool for strategy- and decision-making in clusters. The article proposes a model describing value creation in the cluster context, develops a method for its application in practice as well as a visual representation of both. Moreover, as clusters are increasingly seen as drivers of innovations and mechanisms for a transition towards the knowledge economy, this thesis develops a set of interventions for cluster business model design fostering the innovativeness of its members. Article 2 addresses this topic and applies a mixed methodology combining a systematic literature review with a design-oriented synthesis. This allows to uncover the generative mechanisms of cluster innovativeness and formulate a set of interventions aimed at shaping cluster business model elements with a view to fostering its innovativeness. Second, the meta-organisational perspective on clusters raises important questions about their intentionality and ‘actorhood’. Indeed, seeing clusters as ‘organisations of organisations’ implies that these can deliberately act, just as individual organisations. This view, again, has not yet been explored in the cluster studies, still dominated by the ‘traditional’, determinist, approach. Recent research in the field of organisation studies suggests that organisations may display different levels of ‘organisationality’ depending on the extent to which the attributes of formal organisations are present. Applying this knowledge to clusters allows uncovering the yet unexplored mechanisms of cluster ‘actorhood’ and its limitations. Article 3 explores this topic and applies a theory-elaborating multiple case study method to gather insight into the clusters’ ability to shape their environments mediated by their level of ‘organisationality’. The article develops a set of theoretical propositions based on the case studies of two clusters in Australia. It suggests that clusters can deliberately ‘construct’ themselves both as organisations and social actors. However, their ‘organisationality’ design choices influence the locus of their actorhood resulting in more or less collaborative approaches to social action. Finally, and related to the previous point, viewing clusters as intentional actors capable of interaction with their environments, suggests that these can adopt deliberate strategies in response to external pressures. Going further, clusters can be seen as change agents or institutional entrepreneurs in unsupportive institutional settings. Article 4 explores this topic and adopts a theory-elaborating embedded multiple case study method. It studies two clusters in the context of a transition economy (Russia) presenting a range of institutional barriers to innovation. The article uncovers the dual role of clusters as institutional entrepreneurs. It suggests that clusters may both act collectively due to their powerful position grouping a number of players, and, at the same time, these can contribute to creating enabling conditions for the individual acts of institutional entrepreneurship. While this thesis offers a range of implications for research and practice in the cluster field, its most broad and significant contribution lies in the further development of the novel ‘meta-organisational’ perspective on self-aware and organised clusters. This research thus contributes to the consolidation of the ‘meta-organisational’ perspective and coins new language for addressing the topic of ‘managed’ or ‘organised’ clusters. This perspective has not yet drawn wide attention in cluster research and practice but can be valuable for empowering clusters and giving them practical tools to exercise their collective power and shape their environments. In a way, this ‘meta-organisational’ view of clusters might become ‘self-fulfilling’ by contributing to shaping the perception of clusters as deliberate and organised actors, triggering a reflection of cluster practitioners and providing them with adapted conceptual frameworks and practical tools


BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016433 ◽  
Author(s):  
Anke Richters ◽  
Minke S Nieuwboer ◽  
Marieke Perry ◽  
Marcel G M Olde Rikkert ◽  
Rene J F Melis ◽  
...  

IntroductionPrimary healthcare professionals will increasingly be required to manage and optimise their treatment for patients with dementia. With DementiaNet, we aim to reduce the burden of dementia on healthcare services and society through implementation and facilitation of integrated network-based care with increased dementia expertise. DementiaNet is designed as a stepwise approach including clinical leadership, quality improvement cycles and interprofessional training, which are tailor-made to the local context. For example, the composition of the network and improvement goals are tailored to the local context and availability. Here, we describe the linked evaluation study which aims to provide insight in effectiveness, process and mechanism of the DementiaNet approach through an innovative evaluation design.Methods and analysisWe designed a longitudinal, mixed methods, multiple case study. Study population consists of two levels: (i) local DementiaNet networks of primary care professionals and (ii) patients and informal caregivers who receive care from these networks. At the start and after 12 and 24 months, quantitative data are collected for each network on: level of network maturity, quality of care indicators and outcomes reported by informal caregivers of dementia patients. We assess changes in networks over time and the association with quality of care and informal caregiver-reported outcomes. Throughout the study, logs about each network are registered. Additionally, semi-structured interviews with network members and informal caregivers will provide insight in experiences and opinions regarding effects and mechanisms through which changes in quantitative outcomes are effectuated. Rich narratives will be constructed about the development of the local networks using collected data.Ethics and disseminationThe study protocol was reviewed by the local medical ethics committee; formal judgement was not required (protocol number: 2015–2053). The findings of this study will be disseminated through peer-reviewed publications, conference presentations and presentations for healthcare professionals where appropriate.


Author(s):  
Melanie Elliott ◽  
Paula Gardner ◽  
Miya Narushima ◽  
Lynn McCleary

ABSTRACTAn aging population and increasing rates of dementia point to the need for alternative strategies that allow individuals to age in place. This multiple case study explored, from an insider’s perspective, the role and meaning of music for individuals with dementia who are aging in place. Methods were semi-structured interviews, observations, and videos. The study’s central theme is connection, with three types of “connectors” – self, partner, and music – as subthemes. Connection to self involves present moment awareness, accessing memories, and self-expression. Connection to partner builds on self-connection and spending time together with music. Lastly, the connection to music builds on the previous two subthemes as well as the desire to keep things “normal”. This study provides insight into the growing body of interdisciplinary literature dedicated to dementia, music, aging in place, and contemplative practices, as well as implications for aging and caring for someone with dementia.


2016 ◽  
Vol 54 (1) ◽  
pp. 45-62 ◽  
Author(s):  
Anna-Marié Hall ◽  
Linda C. Theron

Abstract Resilience, or the process of adjusting well to risk, relies on constructive collaboration between youths and their social ecologies. Although the literature details the risks of an intellectual disability (ID), there is little explanation of why some young people cope well despite these risks. Accordingly, we report a multiple case study that affords insight into the resilience of 24 adolescents with ID. Using a draw-and-talk methodology, these young people explained their resilience as enabled primarily by supportive social ecologies (which facilitated behavioral and emotional regulation, encouraged mastery, treated them as agentic beings, and offered safe spaces). Adolescents' positive orientation to their life-worlds co-facilitated their resilience. These insights advance effective ways to champion the resilience of young people with ID.


Pflege ◽  
2020 ◽  
pp. 1-9
Author(s):  
Carola Maurer ◽  
Heidrun Gattinger ◽  
Hanna Mayer

Zusammenfassung. Hintergrund: Einrichtungen der stationären Langzeitpflege investieren seit Jahren Ressourcen in die Entwicklung der Kinästhetikkompetenz der Pflegenden. Aus aktuellen Studien geht hervor, dass die Implementierung, bzw. die nachhaltige Förderung der Kinästhetikkompetenz problematisch ist, vertiefte Erkenntnisse zu den Ursachen fehlen jedoch. Fragestellung: Welche Hemmnisse verhindern eine nachhaltige Implementierung von Kinästhetik in Einrichtungen der stationären Langzeitpflege? Methode: Es wurde eine Multiple Case-Study in drei Einrichtungen der deutschsprachigen Schweiz durchgeführt. Aus leitfadengestützten Interviews und (fallbezogener) Literatur zum externen Kontext wurden in den Within-Case-Analysen die Daten induktiv verdichtet und diese Ergebnisse in der Cross-Case-Synthese miteinander verglichen und abstrahierend zusammengeführt. Ergebnisse: Die Synthese zeigt, dass die Implementierung von Kinästhetik innerhalb der Einrichtung auf drei verschiedenen Ebenen – der Leitungs-, Pflegeteam- und Pflegeperson-Ebene – als auch durch externe Faktoren negativ beeinflusst werden kann. Schlussfolgerungen: In der Pflegepraxis und -wissenschaft sowie im Gesundheitswesen benötigt es ein grundlegendes Verständnis von Kinästhetik und wie dieses im Kontext des professionellen Pflegehandelns einzuordnen ist. Insbesondere Leitungs- und implementierungsverantwortliche Personen müssen mögliche Hemmnisse kennen, um entsprechende Strategien entwickeln zu können.


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